Improving walking via real-time visual feedback after stroke in treadmill training (RE-VISIT): a protocol for randomized controlled trial / Melhorando a caminhada por meio de feedback visual em tempo real após acidente vascular cerebral em treinamento em esteira (RE-VISIT): um protocolo para ensaio clínico randomizado

BACKGROUND: After a stroke, most patients often suffer reduced walking ability and balance. Restoring walking ability and improving balance are major goals of stroke rehabilitation. Treadmills are often used in clinical setups to achieve these goals. Adding dimensions to the visual feedback in addition to the mirror for real-time frontal view is proven to enhance the gait. It is, therefore, important to design additional real-time visual feedback in treadmill training, in particular for the sagittal view involved side. OBJECTIVE: The objective of this study is to test if the real-time sagittal visual feedback during treadmill training is superior to the conventional mirror feedback treadmill training program of equivalent intensity in improving walking speed and balance after stroke. METHODS/DESIGN: The RE-VISIT trial (Real-time Visual feedback after Stroke in Treadmill training) is registered in the Clinical Trial Registry of India (CTRI/2023/10/058299). In this two-arm randomized control trial, which will be a single-blinded study, 42 eligible stroke survivors undergoing rehabilitation will be randomly allocated (1:1 ratio) to either real-time visual sagittal feedback along with front mirror (experimental) group or only front mirror treadmill training (control) group, all the participants will receive 15 sessions of treadmill training for up to 15 min at a safe self-selected speed over 5-6 weeks. The RE-VISIT (experimental) group will receive real-time, visual sagittal view feedback of the involved lower limb trajectory along with the routine front mirror view during treadmill training and will be asked to modify their gait pattern. The control group will receive treadmill walking training only with the routine front mirror view feedback. Clinical and gait assessments will be conducted at the baseline, immediately following the final session of training, and at the 9th week during follow-up. The outcome measures of interest are walking speed (primary) and balance (secondary), which will be measured prior to baseline, post 15 sessions of training, and at the 9th week following training. DISCUSSION: This REVISIT trial will provide insight and contribute to the existing innovation and modifications of incorporating realtime visual feedback during treadmill training in post-stroke gait rehabilitation. The findings will help the better designing of a gait rehabilitation program with a treadmill for post-stroke subjects to improve walking speed, and balance for those who have greater difficulties in community ambulation. We anticipate that those in the REVISIT training will demonstrate improved walking ability.

CONTEXTO: Após o acidente vascular cerebral, a maioria dos pacientes frequentemente sofre redução da capacidade de caminhar e do equilíbrio. Restaurar a capacidade de caminhar e melhorar o equilíbrio são os principais objetivos da reabilitação do AVC. As esteiras são frequentemente usadas em ambientes clínicos para atingir esses objetivos. Está comprovado que adicionar dimensões ao feedback visual, além do espelho para visão frontal em tempo real, melhora a marcha. É, portanto, importante projetar feedbacks visuais adicionais em tempo real no treinamento em esteira, em particular para o lado envolvido na visão sagital. OBJETIVO: O objetivo deste estudo é testar se o feedback visual sagital em tempo real durante o treinamento em esteira é superior ao programa de treinamento em esteira com feedback de espelho convencional de intensidade equivalente na melhoria da velocidade de caminhada e equilíbrio após acidente vascular cerebral. MÉTODOS/ DESENHO: O ensaio RE-VISIT (feedback visual em tempo real após acidente vascular cerebral no treinamento em esteira) está registrado no Registro de Ensaios Clínicos da Índia (CTRI/2023/10/058299). Neste ensaio de controle randomizado de dois braços, que será um estudo cego, 42 sobreviventes de AVC elegíveis em reabilitação serão alocados aleatoriamente (proporção de 1:1) para feedback sagital visual em tempo real junto com grupo de espelho frontal (experimental) ou apenas Grupo de treinamento em esteira com espelho frontal (controle), todos os participantes receberão 15 sessões de treinamento em esteira por até 15 minutos em uma velocidade segura e autosselecionada durante 5-6 semanas. O grupo RE-VISIT (experimental) receberá feedback visual em tempo real da visão sagital da trajetória dos membros inferiores envolvidos, juntamente com a visão rotineira do espelho frontal durante o treinamento em esteira e será solicitado a modificar seu padrão de marcha. O grupo de controle receberá treinamento de caminhada em esteira apenas com o feedback rotineiro da visão do espelho frontal. Avaliações clínicas e de marcha serão realizadas no início do estudo, imediatamente após a sessão final de treinamento e na 9ª semana durante o acompanhamento. As medidas de resultados de interesse são a velocidade de caminhada (primária) e o equilíbrio (secundário), que serão medidos antes da linha de base, após a 15ª sessão de treinamento e na 9ª semana após o treinamento. DISCUSSÃO: este ensaio REVISIT fornecerá insights e contribuirá para a inovação e modificações existentes na incorporação de feedbacks visuais em tempo real durante o treinamento em esteira na reabilitação da marcha pós-AVC. As descobertas ajudarão no melhor desenho de um programa de reabilitação da marcha com esteira para indivíduos pós-AVC para melhorar a velocidade de caminhada e o equilíbrio para aqueles que têm maiores dificuldades na deambulação comunitária. Prevemos que aqueles no treinamento REVISIT demonstrarão melhor capacidade de caminhada.

Impact of asymptomatic genu recurvatum on patellar mobility in young males / Impacto do genu recurvatum assintomático na mobilidade patelar em jovens do sexo masculino

BACKGROUND: Genu recurvatum is one of the most commonly presented lower extremity postural malalignments in individuals. Though genu recurvatum and its impact on impaired knee proprioception, anterior cruciate injuries and posterior soft tissue dysfunctions are reported, its association with patellar mobility is scarcely reported and warrants exploration. OBJECTIVES: To evaluate the medial and lateral patellar mobility differences in adult young males with genu recurvatum and normal knee alignment. METHODS: The ethical approval for this cross-sectional study protocol was obtained and the study was conducted in Research Department of Alva's College of Physiotherapy and Research Centre, Moodubidire, DK, Karnataka, India. The study participants were recruited through an institutional-based musculoskeletal and sports clinic. The estimated sample size for this study was 174. A total of 87 young males with genu recurvatum and 87 young males with normal knee alignment fulfilling the selection criteria were enrolled in two groups. Participants' knee joint was examined by an assessor and individuals with > 5° knee hyperextension were assigned to genu recurvatum group, and individuals with knee extension < 5° from neutral were assigned to the normal knee alignment group. Further, the patellar glide test was performed to examine the presence of patellar hypermobility in both groups. RESULTS: The mean age of the participants in genu recurvatum and normal knee alignment group was 22.04 + 1.860 and 21.91 + 1.869, respectively. A significant higher proportion (86.2%) of participants with genu recurvatum identified with patellar hypermobility compared to normal knee alignment. Within the genu recurvatum subjects, 66.66& and 19.54% were observed to have medial and lateral patellar hypermobility. The odds for occurrence of patellar hypermobility in genu recurvatum was estimated to be 13.007 (95%, CI, 5.481 ­ 30.866), respectively. CONCLUSION: The study result suggests that medial patellar hypermobility is more common in individuals with genu recurvatum. Further study investigating on the mechanism contributing towards medial patellar mobility in genu recurvatum populations could validate the present study findings.

INTRODUÇÃO: Genu recurvatum é um dos desalinhamento posturais dos membros inferiores mais comumente apresentado em indivíduos. Embora o genu recurvatum e seu impacto na propriocepção prejudicada do joelho, lesões cruzadas anteriores e disfunções dos tecidos moles posteriores sejam relatados, sua associação com a mobilidade patelar é pouco relatada e merece exploração. OBJETIVOS: Avaliar as diferenças de mobilidade patelar medial e lateral em homens adultos do sexo masculino com genu recurvatum e alinhamento normal do joelho. MÉTODOS: O protocolo do estudo foi explicado e a aprovação ética para o protocolo do estudo foi obtida e o estudo foi conduzido no Departamento de Pesquisa do Alva's College of Physiotherapy and Research Centre, Moodubidire, DK, Karnataka, India. Os participantes do estudo foram recrutados por meio de clínica musculoesquelética e esportiva de base institucional. O tamanho estimado da amostra para este estudo foi de 174. Um total de 87 jovens do sexo masculino com genu recurvatum e 87 jovens do sexo masculino com alinhamento normal do joelho foram incluídos em dois grupos. A articulação do joelho dos participantes foi examinada por um avaliador e os indivíduos com hiperextensão do joelho > 5° foram designados para o grupo Genu recurvatum, e os indivíduos com extensão do joelho < 5° do neutro foram designados para o grupo de alinhamento normal do joelho. Além disso, o teste de deslizamento patelar foi realizado para examinar a presença de hipermobilidade patelar. RESULTADOS: A média de idade dos participantes do grupo genu recurvatum e alinhamento normal do joelho foi 22,04 + e 21,91 + 1,869, respectivamente. Uma proporção significativamente maior (86,2%) de participantes com genu recurvatum identificados com hipermobilidade patelar em comparação com indivíduos com alinhamento normal do joelho. Entre os indivíduos com genu recurvatum, observou-se que 66,66% e 19,54% apresentavam hipermobilidade patelar medial e lateral. Entre aqueles com alinhamento normal do joelho, 44,83% apresentaram hipermobilidade patelar. A razão de chances para ocorrência de hipermobilidade patelar no genu recurvatum foi estimada em 13,007 (95%, IC, 5,481 ­ 30,866), respectivamente. CONCLUSÃO: O resultado do estudo sugere que a hipermobilidade patelar medial é mais comum em indivíduos com genu recurvatum. Um estudo mais aprofundado que investigue o mecanismo detalhado que contribui para a mobilidade patelar medial em populações de genu recurvatum poderia validar os resultados do presente estudo.

Correlação entre resistência de preensão manual e resistência muscular escapular em indivíduos assintomáticos / Correlation between hand grip endurance and scapular muscle endurance in asymptomatic individuals

INTRODUÇÃO: A atividade de preensão é uma ação diária essencial em casa e no local de trabalho, onde muitas vezes é necessário levantar e segurar cargas com uma preensão relativamente estática usando contração isométrica. A força e resistência muscular no aspecto proximal das extremidades superiores influenciam na função da mão, e indivíduos com força e resistência reduzidas são mais propensos a desenvolver distúrbios musculoesqueléticos relacionados ao trabalho. Uma boa resistência de preensão pode ser influenciada pela estabilização fornecida pelos músculos do ombro. Este estudo tem como objetivo determinar a extensão da correlação entre resistência de preensão manual e resistência muscular da escápula em jovens assintomáticos. MÉTODO: O tamanho da amostra para este estudo foi n = 62, com base em estudos anteriores. Indivíduos saudáveis, com idade entre 18 e 25 anos, de ambos os sexos, foram incluídos. Uma avaliação objetiva da resistência da preensão foi realizada usando um dinamômetro manual hidráulico, e a resistência escapular foi avaliada usando o teste muscular escapular. RESULTADOS: A análise de dados foi realizada usando o SPSS versão 20. Houve correlações positivas significativas entre as medidas de resistência escapular e a resistência de preensão palmar para ambos os lados (teste de correlação de Pearson, r = 0,612 (p < 0,001) e r = 0,524 (p < 0,001), respectivamente, para resistência de preensão da mão não dominante e dominante). CONSIDERAÇÕES FINAIS: Os achados preliminares deste estudo sustentam que a resistência do músculo escapular exibe uma relação com a resistência da preensão palmar, sugerindo que o treinamento de resistência escapular pode ser um complemento eficaz no processo de reabilitação das funções da extremidade superior.

INTRODUCTION: Gripping activity is an essential daily activity at home and at the workplace, where lifting and holding loads with a relatively static grip using isometric contraction is often required. Muscle strength and endurance in the proximal aspect of the upper extremities influence hand function, and individuals with reduced strength and endurance are more prone to developing work-related musculoskeletal disorders. Good grip endurance might be influenced by the stabilization provided by shoulder muscles. This study aims to determine the correlation between hand grip endurance and scapula muscle endurance among young asymptomatic individuals. METHOD: The sample size for this study is n = 62, based on previous studies. Healthy individuals of both genders, aged between 18 and 25 years, were included. An objective assessment of grip endurance was performed using a hydraulic hand dynamometer, while scapular endurance was evaluated using the scapular muscle test. RESULTS: Data analysis was performed using SPSS version 20. There were significant positive correlations between scapular endurance measures and the hand grip endurance on both sides (Pearson correlation test, r = 0.612 (p < 0.001) and r = 0.524 (p < 0.001), respectively, for non-dominant and dominant hand grip endurance). FINAL CONSIDERATIONS: The preliminary findings of this study support the notion that scapular muscle endurance is related to hand grip endurance, suggesting that scapular endurance training may be an effective adjunct in the rehabilitation process for upper extremity functions.

IMPACT OF TIME USAGE IN PRODUCTION SYSTEM

One can use time to make an economic good which transferable but it cannot be sold or oven to somebody. It cannot be stealing. Time goes with each individual. It includes time used for personal are, eating, sleep and rest, medical care and related activities like cooking and shopping etc, these activities are needed for more subsistence. It includes time required to make a living or to keep a house. It is important, because, a substantial part of our lives is spent in working, whether we enjoy it or not “work is life and life is work” says Batten. Time used for work is not available for other activities. Work related time includes time used for such activities as travelling daily to and from work and growing one does for work. The researcher takes survey in the OMEGA ZIPS Company and impact of time usage in the production system.

A Study on Sleep-Pattern and Sleep Hygiene Behaviors Among School Going Adolescents in Semi Urban Coimbatore

Background: Sleep plays an important role in our life. Adolescents undergo several changes with puberty and have a preference for later bedtimes due to internet usage. Evidence shows that many adolescents are not ob-taining the required amounts of sleep (8-10 hours) due to inadequate sleep practices. The objectives of this research were tostudy sleep-pattern among adolescents in Semi urban Coimbatore and also to determine the sleep hygiene practices among the adolescents Methodology: This study is a school based cross-sectional study. A total of 300 adolescents from class VIII to XIIth were selected using simple random sampling. Data was collected from February to May 2018. A struc-tured questionnaire for sleep pattern and Sleep Hygiene Index was used. Results: The adolescents’ mean sleep duration was 7.49 ± 1.12 hours on weekdays and 9.32 ± 1.55 hours on weekends. Mean Sleep Pattern Index (SPI) score was 22.48±6.9 and Mean Sleep Hygiene Index (SHI) score was 17.51±6.3 in our study. Conclusions: Majority of the adolescents had moderate scores of sleep pattern and sleep hygiene practices. Interventions directed towards promoting good sleep hygiene strategies are required to improve the physical and emotional health of adolescents.

Protocol-based Surgical Intervention to Manage Ventricular Septal Rupture from a Tier Two City

ABSTRACT Introduction: This study analyzes the outcome of a protocol-based surgical approach for ventricular septal rupture (VSR). The study also clarifies the appropriate time for intervention. Methods: This is a single-center retrospective analysis of all VSR cases evaluated between February 2006 and March 2020. Cases were managed using the same protocol. Patients were divided into two cohorts - early (those in whom our protocol was instituted within 24 hours of diagnosis) and delayed (intervention between 24 hours and seven days after diagnosis). All-cause mortality was considered as the outcome. Results: The mean age of presentation was 60.1 years, and 75.9% of the patients were men. Cardiogenic shock was the most common mode of presentation. Our analysis validates that once a patient develops VSR, age, sex, comorbidities, left ventricular function, and renal failure at the time of presentation do not have a statistically significant impact on the outcome. The sole factor to have an impact on the outcome was time of intervention. All patients in the delayed cohort expired after surgery, which dragged the overall mortality to 34.5%, whereas 95% of patients in the early cohort are still on follow-up. The mortality in this group was 5% (P≤0.001). Conclusion: Early surgical intervention has proven benefits over delayed approach. Surgical intervention in the early part of the disease reduces the risk and thus improves the outcome. The extreme rarity makes VSR an uncommon entity among surgeons. A protocol-based approach makes the team adapt to this unfamiliar situation better.

Management of diacapitular mandibular condyle fracture using a single lag screw fixation: case report / Manejo de fractura de cóndilo mandibular diacapitular mediante fijación con tornillo de tracción único: reporte de caso

Introduction: Mandibular fractures are the most common facial fractures affecting various anatomical sites of the mandible. Among the various mandibular fractures, management of condylar fractures remains a challenging task for surgeons. Case Report: We report the case of a 28 year old male patient who presented with pain in the chin and restricted mouth opening. Computed tomography revealed a sagittal fracture of the right condylar head with medial displacement of the fractured fragments. Management of diacapitular fractures includes open reduction and internal fixation of the right condyle using a single lag-screw. Results: The postoperative outcomes were favorable, where normal mandibular movements, desired dental occlusion and exact positioning of the condyle with rigid fixation were established thereby maintaining the shape of the condyle. Conclusion: Use of single lag screw fixation is highly recommended as it greatly supports the stabilized fracture fragments and also aid in prevention of fracture fragment rotation medially.

Introducción: Las fracturas mandibulares son las fracturas faciales más comunes que afectan a diversos sitios anatómicos de la mandíbula. Entre las diversas fracturas mandibulares, el manejo de las fracturas condilares sigue siendo una tarea desafiante para los cirujanos. Reporte del Caso: Presentamos el caso de un paciente masculino de 28 años que consultó por dolor en el mentón y restricción de la apertura de la boca. La tomografía computarizada reveló una fractura sagital de la cabeza condilar derecha con desplazamiento medial de los fragmentos fracturados. El tratamiento de las fracturas diacapitulares incluye la reducción abierta y la fijación interna del cóndilo derecho con un solo tirafondo. Resultados: Los resultados postoperatorios fueron favorables, donde se establecieron los movimientos mandibulares normales, la oclusión dentaria deseada y el posicionamiento exacto del cóndilo con fijación rígida manteniendo así la forma del cóndilo. Conclusión: Se recomienda encarecidamente el uso de una fijación con un solo tornillo de tracción, ya que soporta en gran medida los fragmentos de fractura estabilizados y también ayuda a prevenir la rotación medial de los fragmentos de fractura.

Epidural steroid injection in herniated disc and lumbar canal stenosis: is it just a placebo? / Injeção epidural de esteroides em hérnia de disco e estenose do canal lombar: é apenas um placebo? / Inyección epidural de esteroides en hernia de disco y estenosis del canal lumbar: ¿es solo un placebo?

ABSTRACT Objective To study the role of epidural steroid injection (ESI) in patients with lumbar disc herniation (LDH) and lumbar canal stenosis (LCS). ESIs are regularly used to support non-operative treatment for LBP, and our anecdotal impression is that a considerable proportion of patients report substantial pain relief after ESI. Methods One thousand consecutive patients (645 patients with LDH and 355 patients with LCS) who required ESI from January-August 2018 were included. All were given the same ESI, prepared with triamcinolone (80 mg), bupivacaine (0.25%, 4 ml) and normal saline (4 ml). Patients were evaluated using the numerical rating scale (NRS) immediately after the injection, after 7 days, and after 3 months. Results The mean NRS back-pain score of the LDH-group was reduced from 5 (range: 4-8) to 4 (range: 2-7) immediately after injection, 2 (range: 1-7) after 7 days and 2 (range: 1-7) after 3 months (p-value<0.001). The mean NRS back-pain score of the LCS-group was reduced from 5 (range: 4-8) to 4 (range: 2-7) immediately after injection, 2 (range: 1-7) after 7 days and 3 (range: 1-7) after 3 months (p-value <0.001). The mean NRS leg-pain score of the LDH group was reduced from 5 (range: 4-9) to 3 (range: 3-7) immediately after injection, 1 (range: 1-6) after 7 days and 2 (range: 1-7) after 3 months (p-value <0.001). The mean NRS leg-pain score of the LCS group was reduced from 5 (range: 4-9) to 4 (range: 3-7) immediately after injection, 3 (range: 1-7) after 7 days and 2 (range 1-6) after 3 months (p-value <0.001). Conclusion ESI causes statistically significant improvement in back and leg pain in patients with LDH and LCS. However, the short and medium-term efficacy of ESI in the LCS group was lower than in the LDH group. Level of evidence IV; Prospective hospital-based study.

RESUMO Objetivo Estudar o papel da injeção epidural de esteroides (IEE) em pacientes com hérnia de disco lombar (HDL) e estenose do canal lombar (ECL). As IEEs são usadas regularmente para dar suporte ao tratamento não cirúrgico da dor lombar e nossa impressão empírica é que uma proporção considerável de pacientes relata alívio substancial da dor depois da IEE. Métodos Foram incluídos mil pacientes consecutivos (645 pacientes com HDL e 355 pacientes com ECL) que precisaram de IEE de janeiro a agosto de 2018. Todos receberam a mesmo IEE preparada com triamcinolona (80 mg), bupivacaína (0,25% 4 ml) e solução salina normal (4 ml). Os pacientes foram avaliados pela Escala de Estimativa Numérica (NRS, Numeric Rating Scale) imediatamente, 7 dias e 3 meses depois. Resultados O escore médio de dor nas costas da NRS no grupo HDL foi reduzida de 5 (intervalo: 4-8) para 4 (intervalo: 2-7) imediatamente após a injeção, para 2 (intervalo: 1-7) após 7 dias e para 2 (intervalo: 1-7) após 3 meses (valor de p < 0,001). O escore médio de dor nas costas do NRS do grupo ECL foi reduzida de 5 (intervalo: 4-8) para 4 (intervalo: 2-7) imediatamente após a injeção, para 2 (intervalo: 1-7) após 7 dias e para 3 (intervalo: 1- 7) após 3 meses (valor de p <0,001). O escore médio de dor na perna da NRS do grupo HDL foi reduzida de 5 (intervalo: 4-9) para 3 (intervalo: 3-7) imediatamente após a injeção, para 1 (intervalo: 1-6) após 7 dias e para 2 (intervalo: 1-7) após 3 meses (valor de p < 0,001). O escore médio de dor na perna da NRS do grupo ECL foi reduzida de 5 (intervalo: 4-9) para 4 (intervalo: 3-7) imediatamente após a injeção, para 3 (intervalo: 1-7) após 7 dias e para 2 (intervalo 1-6) após 3 meses (valor de p < 0,001). Conclusão A IEE causa melhora estatisticamente significativa das dores nas costas e nas pernas em pacientes com HDL e ECL. No entanto, a eficácia a curto e médio prazo da IEE na ECL foi menor do que a da HDL. Nível de evidência IV; Estudo prospectivo baseado em hospital.

RESUMEN Objetivo Estudiar el papel de la inyección epidural de esteroides (IEE) en pacientes con hernia de disco lumbar (HDL) y estenosis del canal lumbar (ECL). Las IEE se utilizan regularmente para respaldar el tratamiento no quirúrgico del dolor lumbar y nuestra impresión empírica es que una proporción considerable de pacientes informa alivio sustancial del dolor después de la IEE. Métodos Se incluyeron mil pacientes consecutivos (645 pacientes con HDL y 355 pacientes con ECL) que necesitaron IEE de enero a agosto de 2018. A todos se les administró la misma IEE preparada con triamcinolona (80 mg), bupivacaina (0,25% 4 ml) y solución salina normal (4 ml). Los pacientes fueron evaluados usando una Escala de Valoración Numérica (NRS, Numeric Rating Scale) inmediatamente, 7 días y de 3 meses después. Resultados La puntuación media de dolor de espalda de la NRS del grupo HDL se redujo de 5 (rango: 4-8) a 4 (rango: 2-7) inmediatamente después de la inyección, a 2 (rango: 1-7) después de 7 días y a 2 (rango: 1-7) después de 3 meses (valor de p < 0,001). La puntuación media de dolor de espalda de la NRS del grupo ECL se redujo de 5 (rango: 4-8) a 4 (rango: 2-7) inmediatamente después de la inyección, a 2 (rango: 1-7) después de 7 días y a 3 (rango: 1- 7) después de 3 meses (valor de p < 0,001). La puntuación media de dolor de pierna de la NRS del grupo HDL se redujo de 5 (rango: 4-9) a 3 (rango: 3-7) inmediatamente después de la inyección, a 1 (rango: 1-6) después de 7 días y a 2 (rango: 1-7) después de 3 meses (valor p < 0,001). La puntuación media de dolor de pierna de la NRS del grupo ECL se redujo de 5 (rango: 4-9) a 4 (rango: 3-7) inmediatamente después de la inyección, a 3 (rango: 1-7) después de 7 días y a 2 (rango 1-6) después de 3 meses (valor p < 0,001). Conclusión IEE causa una mejoría estadísticamente significativa en el dolor de espalda y piernas en pacientes con HDL y ECL. Sin embargo, la eficacia a corto y medio plazo de la IEE en la ECL fue menor que la de HDL. Nivel de evidencia IV;Estudio prospectivo basado en hospitales.

Mechanodefibrillator dissociation due to prolonged sinus arrest / Mecano disociación del desfibrilador debido a un paro sinusal prolongado

To the editor, Sinus arrest and cardiac arrest are two different terms which are often confused by many. This confusion often leads to inappropriate cardiopulmonary resuscitation (CPR) when patient is connected to defibrillator. Sinus arrest is defined as transient pause in Sino-atrial firing for more than 3 s1. When sinus arrest occurs, other latent pacemakers (atrial myocardium, cells nearby atrioventricular node, and His purkinje system) usually starts firing until Sino-atrial node recover. Sinus arrest can be prolonged till other pacemakers starts firing2. Cardiac arrest occurs when these latent pacemakers does not take up the job of alternate firing. Prolonged sinus arrest in a defibrillator may look like a cardiac arrest which might lead to unnecessary CPR. Here, we would like the put forward a new term “mechano - defibrillator dissociation” which occurs because of prolonged sinus arrest. We should be aware this, so that inappropriate CPR could be avoided. We, emergency physician also faced similar situation while resuscitating a patient because of mechano - defibrillator dissociation caused by prolonged sinus arrest/pseudo cardiac arrest. A 52-year-old male diabetic, hypertensive, and chronic alcoholic came to our emergency department (ED) with history of giddiness, syncope, and palpitation. On arrival to ED, patient was drowsy, diaphoretic, and hypotensive. Patient was connected to defibrillator which showed a heart rate of 35/min and saturation was 90% in room air. ECG showed complete heat block (CHB) and point of care echocardiography showed reduced ejection fraction.

Remineralization efficacy of nonfluoride versus herbal-based pediatric dentifrice in demineralized primary teeth

Background: Dental caries is one of the most prevalent posteruptive bacterial infections worldwide, characterized by a progressive demineralization process that affects the mineralized dental tissues. Although the decline of dental caries prevalence can be attributed to the widespread use of dentifrices that contain fluoride, yet there is a need for an advanced alternative nonfluoride remineralizing dentifrice. Yet, there is a need for an advanced alternative nonfluoride remineralizing dentifrice. Aim: The aim of this study was to evaluate and compare the remineralizing effect of nonfluoride-based and herbal-based pediatric dentifrice in demineralized primary teeth with an ideal in vitro method of pH cycling and evaluating the values under Polarized Light Microscope (Olympus BX43) using image analysis software (ProgRes, Speed XT core3). Materials and Methods: A total of 30 tooth samples were collected and placed in the demineralizing solution for 96 h to produce a demineralized lesion of approximately 100 ?m, and then cut longitudinally into 60 sections that were randomly assigned to two groups with 27 samples each, Group A – nonfluoride-based dentifrice (Mee Mee®), Group B – herbal-based dentifrice (Mamaearth™), after which they were subjected to pH cycling for 7 days along with dentifrice slurry preparation. The sections were evaluated under the polarizing light microscopy for remineralizing efficacy. The lesion depth was measured and tabulated to be sent for statistical analysis. Results: The mean demineralization value for nonfluoride and herbal-based dentifrice groups were 7.8730 ?m and 28.3174 ?m, respectively. Hence, it can be inferred that since lesion depth measured was lesser in nonfluoride than herbal-based dentifrice, remineralization has occurred in the nonfluoride-based dentifrice group. Conclusion: Nonfluoride-based dentifrice showed significant results in remineralizing the demineralized lesion, while herbal-based dentifrice showed poor efficiency in remineralizing the demineralized lesion.

Outcomes of oesophageal cancer treated with neoadjuvant compared with definitive chemoradiotherapy

INTRODUCTION@#We report outcomes of patients with oesophageal cancer treated with neoadjuvant chemoradiotherapy (NACRT) plus surgery or definitive chemoradiotherapy (chemoRT) at our institution.@*METHODS@#We retrospectively reviewed patients who underwent chemoRT from 2005 to 2017. The primary outcome was overall survival (OS). Secondary outcomes were disease-free survival (DFS) and toxicities.@*RESULTS@#We identified 96 patients with median age of 64 years and squamous cell carcinoma in 82.3%. Twenty-nine patients (30.2%) received NACRT plus surgery, 67 patients (69.8%) received definitive chemoRT. Median follow-up was 13.5 months. The 3/5-year OS were 26.4%/13.4%, and 59.6%/51.6% in the definitive chemoRT and NACRT plus surgery groups, respectively. The 3/5-year DFS were 19.3%/12.3%, and 55.7%/37.2% in the definitive chemoRT and NACRT plus surgery groups, respectively. NACRT plus surgery significantly improved OS (hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.22-0.72, @*CONCLUSION@#NACRT plus surgery improved OS and DFS. However, in view of treatment-related complications, careful selection of patients is warranted. With the predominant histology of our cohort being squamous cell carcinoma (SCC), our results may be more relevant for those with SCC.

Fatal outcome of congenital aortopulmonary window with patent ductus arteriosus complicating pregnancy

Aortopulmonary window (APW) is a rare congenital heart defect with abnormal communication between the ascending aorta and the pulmonary trunk with two separate semilunar valves. We present an autopsy case report wherein a young primigravida woman presented with progressive breathlessness and central cyanosis at 21 weeks of gestation. Echocardiography performed in the emergency room revealed elevated right-sided cardiac pressures suggestive of severe pulmonary hypertension; however, no structural cardiac defect was discernible. The patient succumbed to congestive cardiac failure and progressive hypoxia within 5 days of hospitalization. The autopsy revealed a Type I aortopulmonary window (2 cm) with patent ductus arteriosus. The lungs showed changes of severe pulmonary hypertension with superadded bronchopneumonia. This report underscores a rare presentation of APW, undiagnosed until pregnancy, leading to the Eisenmenger syndrome and death.

De novo double-hit B-cell precursor leukemia/lymphoma - an unusual presentation as peritoneal lymphomatosis

Peritoneal lymphomatosis (PL) is a rare presentation of extranodal precursor leukemia/lymphoma. The presentation is often non-specific, leading to delayed diagnosis and treatment. In this case, though the preliminary diagnosis was established on ascitic fluid cytology, the disease progressed rapidly, leading to demise before initiating chemotherapy. Immunophenotyping and molecular studies, performed later, established a diagnosis of de novo B-cell precursor leukemia/lymphoma with MYC, BCL2 rearrangements (Double-hit lymphoma). MYC, BCL2 rearrangements are rarely reported in precursor B-lymphoma/leukemia which carry dismal prognosis. In this report, we illustrate autopsy findings of PL in an elderly gentleman who presented with ascites for evaluation.

Primary diffuse large B-cell lymphoma of the CNS, with a "Lymphomatosis cerebri" pattern

We describe an unusual case of lymphomatosis cerebri in a middle-aged lady presenting with rapid-onset dementia. The lymphomatous infiltrate, instead of forming mass lesions, percolated throughout the brain parenchyma, which is often missed on a stereotactic biopsy and hence warrants caution and awareness about this entity. The nonspecific symptoms at presentation and a variable picture at imaging make this entity diagnostically challenging.

A rare clinical entity of asymptomatic adult bochdalek hernia

Bochdalek hernia (BH) is the commonest congenital diaphragmatic hernia, caused by the failure of the posterolateral diaphragmatic foramina to fuse properly. It is extremely rare in adults and accounts for 5-10%. Presenting a case of 48 years female with complaints of dry cough and left chest pain for 1 week. Diminished breath sounds and abnormal gurgling sounds heard on auscultation of left chest wall. X-ray chest showed elevated left hemi diaphragm and gastric bubble. Computed tomography (CT) chest revealed left diaphragmatic hernia with splenic flexure, transverse colon, mesocolon, spleen and upper pole of left kidney as content and atelectasis of left lung lower lobe. Patient underwent laparoscopic repair of hernia with mesh plasty. Intraoperatively, the contents were reduced into the abdominal cavity and left lung expansion noted. The defect of size 6×10 cm in the left diaphragm was sutured and composite mesh placed. Post-operative chest x-ray showed expanded left lung. On follow up of patient after 2 weeks and 1 month, patient was asymptomatic. BH in adults is an uncommon. The contents can be reduced via thoracic or abdominal approach, with abdominal approach having easier access. With the advent of minimal access techniques, delineating clear anatomy, more working space, early recovery, and early return to home and work is possible. Thus, laparoscopic repair of adult diaphragmatic hernia is a safe and effective modality of surgical treatment.

Vulval carcinoma at the site of recent Bartholin gland excision: a rare case report

Around 2-7% of all vulvar cancers are represented by primary carcinomas of Bartholin gland. Here we are presenting such a rare case of carcinoma of Bartholin gland. 45/F P2L2 presented in our OPD with non-healing lesion in vulva for 2 months. She had history of Bartholin’s cyst excision (elsewhere), 2 months back (the exact time since when she is having the non-healing lesion in vulva). Diagnostic biopsy revealed it to be vulval squamous cell carcinoma. She was given two cycles of Neo adjuvant chemotherapy (Inj. Paclitaxel and Carboplatin). In view of better response to the treatment patient was planned for surgery. Patient underwent wide local excision with bilateral inguinofemoral lymphadenectomy. Although the majority of vulvar lesions are benign, especially in women younger than 50 years of age, any solid mass should be carefully evaluated for malignancy. Preferably biopsy of Bartholin gland should be considered if the patient is more than 40 years of age and should be mandatory in a menopausal woman.

Surgical management of a case of recurrent carcinoma cervix: a case report

Worldwide cervical cancer is the fourth most common cancers among females. Pelvic recurrence, distant metastases, or a combination of both can occur in patients of carcinoma cervix. A 42-year-old P2L2 with a history of carcinoma cervix stage 3-b came to our OPD for routine follow up. Two year back she was managed with chemoradiation for her primary carcinoma which had parametrium extension. There was a 1 × 1 cm lesion on the anterior vaginal wall which was diagnosed to be cervical recurrence. Patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Patient is disease free till now. Treatment decisions should be individualised based on the performance status of the patient, the site of recurrence and/or metastases, the extent of metastatic disease, and prior treatment.

Effect of CO2 Insufflation on Corrected QT Interval Prolongation during Laparoscopic Surgeries: A Prospective Observational Study

Introduction: Laparoscopic surgeries in various surgical specialties are most routinely performed with general anesthesia. Thephysiological effects of intra-abdominal CO2 insufflation combined with the variations in patient positioning can have a majorimpact on cardiorespiratory function. Prolongation of corrected QT interval (QTc) has been known to predispose torsades depointes, a potentially fatal ventricular arrhythmia may occur during CO2 insufflation. Our aim is to evaluate the effect of insufflationof CO2 on QT interval and QTc during prolonged laparoscopic surgeries.Methodology: Fifty patients of American Society of Anesthesiologists physical status 1 and 2, of either sex, between the agesof 25 and 65 years posted for laparoscopic surgeries included in the study. After general anesthesia, we measured mean arterialpressure, heart rate, SpO2 and ETCO2 before anesthesia induction, before CO2 insufflation, 30, 60, 120, and 150 min after CO2insufflation, 5 min after CO2 deflation, and at the end of surgery. We observed statistically significant increase of QTc intervalaround 120 min after CO2 insufflation.Conclusion: The cause of this QTc interval prolongation is multifactorial and clinical significance of producing life-threateningcardiac arrhythmias has to be determined.

Prevalence of depression among the elderly in urban area of Perambalur district

Background: Depression at any age needs attention. Geriatric population being most vulnerable, are more prone to many morbidities, physically and mentally. Geriatric depression is one among them which needs prompt attention. The objectives of the present study were to estimate the prevalence of geriatric depression and association of depression with various sociodemographic factors.Methods: A cross sectional study carried out among 300 geriatric subjects. A structured interview schedule was used to collect data.Results: The prevalence of depression was found to be 44.4%. Female gender, marital status, family type was found to be positively associated with depression.Conclusions: Geriatric depression in our study is found to be on little higher side. Lifestyle modifications and support from family members are needed to improve the quality of life of these people.